21 Aug 12

What’s Wrong with Health Care?

Today I’m hurting in five places. The tip of my left index finger, my upper left arm, my left hip, my left quadricep, and my right quadricep are all kind of tender and swollen. The shots I received feel about half as painful as my tetanus shot was. However, I got five of them. But I don’t mind. A few lumps and bumps are better than getting rabies.

I volunteer working with wildlife rehabilitation and yesterday the recovery room for mammals was a real pigsty. Or mammalsty. Whatever. Normally young raccoons are very curious and friendly, often to the point that we have to take precautions against letting them imprint on humans. One was not in the mood to be removed from his enclosure, even though he and his bunkmate had covered the walls in food and poo. The technique for handling distressed animals generally works: get ahold of them quickly and hold them firmly but gently. Get them into a nice dark box so they can feel safe while their enclosure gets tidied up, and get them back into it as soon as possible.

This guy was freaking out from the get go, growling and hissing. I did my best, but he managed to nip me on the end of my finger. I don’t blame the little guy one bit. He was new to the shelter and was clearly stressed out from losing his mother and being tossed in a cage by giants with predator-style binocular vision and opposable thumbs. I probably would have bit and scratched too. It wasn’t a bad bite at all, as he was just a half-grown guy. I washed it with soap and hot water and finished out my shift. At first I thought nothing of it, but I reconsidered and rang up my totally awesome super caring general practitioner just to be safe. She told me to get my booty to Urgent Care and get a rabies shot.

So, silly me, I did what my doctor told me. I went to my health network’s Urgent Care facility, and they told me to get lost. Yes, I needed a rabies shot, but no, they wouldn’t treat me. Why? Because even though I’m just a volunteer, it’s a workman’s compensation case, and they don’t handle those.

Wait — what? There’s a chance I may be infected with a virus that is 100% fatal if left untreated, and they won’t treat me? Because of the physical location I was in when I was injured? What’s that? I have to go to the nearest Emergency Room to be treated, and I’ll have to walk almost two miles since I don’t have my car with me? Isn’t Emergency off-network care more costly to provide? Won’t I have to wait a long time — again — to see somebody? Won’t I have to pay more because this can’t be covered by my insurance, which I presumably bought so that I can get health care when I need it?

Let’s see. I am a patient in need of medical attention. A health care provider has the ability to help me. I am even willing to pay for my portion of the cost. And they won’t see me. Why? Is it because someone is bleeding to death and they need every doctor in the house? Is it because a woman is in labor right now and they need every doctor to play catch? Is it because a child has a compound fracture and everyone is needed to get the wound closed?

No, silly girl! Patient-centered care is for socialists! They won’t see me because it’s not cost effective to deal in workman’s comp cases. Had I walked in and told them that I had been bitten by a raccoon in my yard, they would have given me the jabs I needed right away. I didn’t know any of this nonsense when I came in, so I was truthful in my account of what happened. But I guess I should have known that what I really needed to do was lie to a doctor in order to get treatment.

This seems like an incredibly backwards approach to medicine. The phrase “Health Care Industry” is an oxymoron. You can’t pay people to care. So either it’s Health Care or Health Industry. Looks like I found out which one it is. Plus, it doesn’t seem wise to me to piss of someone who might have rabies. They just might choose that moment to give in to their irresistible urge for human flesh.

I reviewed the facts of the case with the triage nurse who was seeing me at Urgent Care:

Me: Wait. So I need a rabies shot?

Nurse: Definitely.

Me: And you have a rabies shot in this building?

Nurse: Yes.

Me: And you’re capable of administering the shot?

Nurse: Yes.

Me: But you won’t.

Nurse: We don’t handle workman’s comp issues.

Me: My geographic location at the time of injury should not matter more to you than my injury.

Nurse: Did they fill out an incident report when this happened? Because if they didn’t then you’ll probably have to pay all of your emergency room fees.

Me: I can just pay a regular co-pay if you treat me now on network, and we can keep non-profit organizations and my wallet far away from expensive emergency fees.

Nurse: We can’t do that.

Me: I realise this isn’t your fault personally, but doesn’t this seem like a violation of the Hippocratic Oath?

Nurse: . . . . . . .

They must kick a lot of people out of Urgent Care, because they gave me a pre-printed map showing me how to get to the nearest Emergency Room. By now I was feeling very grumpy indeed and my finger still hurt and my husband was trying to get to me as quickly as possible but he wasn’t there yet, so I called my mom and whined. She got appropriately indignant on my behalf, and then I felt 12.7% better.

The Emergency Room was busy, as expected, with a variety of teary-eyed children, sneezing elders, and moochers looking for free hospital food milling about. I had to go through a medical detector and be screened by a security guard before I could go in. He gave me a medical mask and told me I didn’t have to wear it, but I had to take one.

Okay. So far this visit’s fees are going to include the cost of maintaining a metal detector, the paycheck for a rent-a-cop, and one wasted hospital mask.

Unlike my on-network Urgent Care clinic, there was no fish tank and classical music in the waiting room. There were a lot of stalwart doctors and nurses doing their best to triage people quickly and separate us into three groups: those who could be treated quicky, those who would need longer-term care, and people who were faking it to get some Vicodin.

They didn’t know what to make of me, as the triage nurse had never seen a rabies case. They’re just not common any more, thank goodness. I was fast-tracked into a quick treatment group, where a very nice nurse brought me a sippy cup of ice water and a very nice doctor tried to figure out what to do with me.

He told me that normally with wild animal bites, if the animal in question was available, it was supposed to have its head lopped off so they could check its brain for rabies before giving a rabies vaccine.

I told him that there was absolutely no way not in a million years ain’t gonna happen was I going to allow that to happen. I have an ethical commitment to the animals in the Wildlife department, and cutting the head off of one of our patients just because it gave me a nibble is not acceptable.

Lucky for me the doctor seemed sympathetic to this, so he agreed that I should be dosed for both passive and active immunity. I’d be getting a set of injections that would both counteract the effects of any potential infection I contracted from the bite, and begin the round of vaccinations that would make me immune from any future bites and scratches I will most definitely sustain whilst handling wild animals.

So the nurse comes in and she’s holding a syringe the size of a garden hose. The first injection went into my fingertip to infuse the site of injury with immunoglobulins. That felt like . . . well, a needle being stuck into my fingertip. But I think I took it like a champ.

The next one went into my left deltoid, and while I’d rather have a nice ham sandwich than a rabies shot, that wasn’t so bad either. It contained the same counteractive medicine that was shot into my finger, and would spread throughout my arm and then onto the rest of my body to prevent any possible rabies virus from taking hold.

Then came the fun stuff. I got to put on a sexy hospital gown to get ready for the big jab, which would create active immunity against future wildlife mishaps. The first jab went into my left quadricep, and honestly I didn’t feel much other than the odd sensation of cool liquid spreading beneath my skin, which suddenly felt squidgy, as if jell-o had gotten stuck underneath it. Then she moved the needle to pump more into the side of my thigh.

“WHOA MAMA THAT ONE STINGS,” I said with great dignity.

“Oh, I’m so sorry, do you want me to stop?” the nurse asked, retracting the needle a bit.

“NO GET IT OVER WITH,” I requested with all politeness.

So she pumped a bunch more squidgy cold goo into me, and then put the rest of it into my right quadricep. All done. Five injections. Nearly 10ccs. That’s almost triple the volume of what I feed a baby squirrel at mealtime. They made me wait for fifteen minutes to see if I’d have a reaction to the vaccine that was worse than rabies, and then they let me go home, but only after giving me a bunch of paperwork warning me how expensive this whole thing was going to be if workman’s comp wouldn’t cover it. The whole ordeal had taken almost five hours.

And now I have the fun news that my on-network health care still won’t help me, and that my health insurance won’t cover anything, because I was bitten while working as a volunteer. Lolwut? I don’t want to hurt the non-profit I work with. I don’t want to hurt the animal I was helping. But it seems like because I was naive and trusting and truthful in my account of my injury, foolishly thinking that my health care provider would want to provide health care, I’m getting the runaround and might get stuck with a massive bill for treatment that, in theory, is necessary to keep me alive. Even worse, if this goes the official route, the way the paperwork insists, the life of the little raccoon could be on the line. And just think — this whole mess could have been avoided if I’d just been savvy enough to say that I wasn’t bitten while volunteering with animals.

If only I’d known that lying could have been the most ethical medical choice, saving time, money, resources, and maybe even the life of a vulnerable frightened motherless raccoon.